WR2

Florida High School Athletic Association Revised 09/11

Wrestler Skin Condition Examination Report Form

This form must be used by member schools. Photocopy this form and provide a copy to the student-athlete who is being referred to a physician for examination of a
skin condition. The physician must complete, sign and return the form to the student-athlete who then must present it to the athletic director or head coach before resum-
ing contact practice or competition. Any approval issued by a physician is valid for a maximum of seven (7) days from the date of the examination, unless otherwise
stated by the physician.

NFHS PHYSICIAN RELEASE FOR WRESTLER TO PARTICIPATE WITH SKIN LESION(S)

The National Federation of State High School State Associations’ (NFHS) Sports Medicine Advisory Committee has developed a medical release
form for wrestlers to participate with skin lesion(s) as a suggested model you may consider adopting for your state. The NFHS Sports Medicine Ad-
visory Committee conducted a survey among specialty, academic, public health and primary care physicians and reviewed extensively the literature
available on the communicability of various skin lesions at different stages of disease and treatment. No definitive data exists that allow us to abso-
lutely predict when a lesion is no longer shedding organisms that could be transmitted to another wrestler. Another finding from the survey was the
significant differences that exist among physicians relating to when they will permit a wrestler to return to participation after having a skin infection.

Neither the NFHS nor the NFHS Sports Medicine Advisory Committee presumes to dictate to professionals how to practice medicine. Neither is
the information on this form meant to establish a standard of care. The NFHS Sports Medicine Advisory Committee does feel, however, that the
guidelines included on the form represent a summary consensus of the various responses obtained from the survey, from conversations and from the
literature. The committee also feels that the components of the form are very relevant to addressing the concerns of coaches, parents, wrestlers and
appropriate health-care professionals that led to the research into this subject and to the development of this form.

GOALS FOR ESTABLISHING A WIDELY USED FORM:

1. Protect wrestlers from exposure to communicable skin disorders. Although most of the skin lesions being discussed generally have no ma-
jor long term consequences and are not life threatening, some do have morbidity associated with them and student-athletes should be protected from
contracting skin disorders from other wrestlers or contaminated equipment such as mats.

2. Allow wrestlers to participate as soon as it is reasonably safe for them and for their opponents and/or teammates using the same mat.

3. Establish guidelines to help minimize major differences in management among appropriate health-care professionals who are signing
“return to competition forms”. Consistent use of these guidelines should protect wrestlers from catching a skin disease from participation and should
protect them from inequalities as to who can or cannot participate.

4. Provide a basis to support appropriate health-care professional decisions on when a wrestler can or cannot participate. This should help the
appropriate health-care professional who may face incredible pressure from many fronts to return a youngster to competition ASAP. This can involve
any student athlete who never wins a match or the next state champion with a scholarship pending.

IMPORTANT COMPONENTS FOR AN EFFECTIVE FORM:

1. Each state association needs to determine which health-care professional can sign off on this form.

2. Inclusion of the applicable NFHS wrestling rule so appropriate health-care professionals will understand that covering a contagious lesion
is not an option that is allowed by rule. Covering a non-contagious lesion after adequate therapy to prevent injury to lesion is acceptable.

3. Inclusion of the date and nature of treatment and the earliest date a wrestler can return to participation. This should minimize the need for a
family to incur the expense of additional office visits as occurs when a form must be signed within three days of wrestling as some do.

4. Inclusion of a “bodygram” with front and back views should clearly identify the lesion in question. Using non-black ink to designate skin
lesions should result in less confusion or conflict. Also including the number of lesions protects against spread after a visit with an appropriate
health-care professional.

5. Inclusion of guidelines for minimum treatment before returning the wrestler to action as discussed above. This should enhance the likeli-
hood that all wrestlers are managed safely and fairly.

6. Inclusion of all of the components discussed has the potential to remove the referee from making a medical decision. If a lesion is ques-
tioned, the referee’s role could appropriately be only to see if the coach can provide a fully completed medical release form allowing the wrestler to
wrestle.

This form may be reproduced, if desired and can be edited in anyway for use by various individuals or organizations. In addition, the NFHS Sports
Medicine Advisory Committee would welcome comments for inclusion in future versions as this will continue to be a work in progress.

–1–
 WR2
Florida High School Athletic Association Revised 09/11

Wrestler Skin Condition Examination Report Form

This form must be used by member schools. Photocopy this form and provide a copy to the student-athlete who is being referred to a physician for examination of a
skin condition. The physician must complete, sign and return the form to the student-athlete who then must present it to the athletic director or head coach before resum-
ing contact practice or competition. Any approval issued by a physician is valid for a maximum of seven (7) days from the date of the examination, unless otherwise
stated by the physician.

Student Name: ________________________________________ School: _________________________________________ Date of Exam: ______ / ______ / ______

Diagnosis: __________________________________________________________________ Mark location(s) and number of lesion(s)



___________________________________________________________________________

Location(s) and number of lesion(s): _____________________________________________

___________________________________________________________________________

Medication(s) used to treat lesion(s): _____________________________________________

___________________________________________________________________________

Date treatment started: ______ / ______ / ______

Form expiration date: ______ / ______ / ______

Note: This form is invalid seven (7) days from the date of the examination.

Earliest date student may return to participation: ______ / ______ / ______

STATEMENT OF PROVIDER. I have examined the above-named student and determined the condition(s) marked on the diagram IS/ARE NOT communicable.

_________________________________________________________________ _______________________________________________________________
Name of Provider (printed or typed) Signature of Provider

_________________________________________________________________________________________________ ( _______ ) __________________________

Office Address (Street or PO Box, City, State, Zip) Office Phone Number

Note to Appropriate Health-Care Professionals: Non-contagious lesions do not require treatment prior to return to participation (e.g. Eczema, psoriasis, etc.). Please
familiarize yourself with NFHS Rules 4-2-3, 4-2-4 and 4-2-5 which states:

“ART. 3 . . . If a participant is suspected by the referee or coach of having a communicable skin disease or any other condition that makes participation ap-
pear inadvisable, the coach shall provide current written documentation as defined by the NFHS or the state associations, from an appropriate health-care
professional stating that the suspected disease or condition is not communicable and that the athlete’s participation would not be harmful to any opponent. This
document shall be furnished at the weigh-in for the dual meet or tournament. The only exception would be if a designated, on-site meet appropriate health-care
professional is present and is able to examine the wrestler either immediately prior to or immediately after the weigh-in. Covering a communicable condition
shall not be considered acceptable and does not make the wrestler eligible to participate.”
“ART. 4 . . . If a designated on-site meet appropriate health-care professional is present, he/she may overrule the diagnosis of the appropriate health-care profes-
sional signing the medical release form for a wrestler to participate or not participate with a particular skin condition.”

“ART. 5 . . . A contestant may have documentation from an appropriate health-care professional only indicating a specific condition such as a birthmark or other
non-communicable skin conditions such as psoriasis and eczema, and that documentation is valid for the duration of the season. It is valid with the understanding
that a chronic condition could become secondarily infected and may require re-evaluation.”

Once a lesion is not considered contagious, it may be covered to allow participation.

Below are some treatment guidelines that suggest MINIMUM TREATMENT before return to wrestling:

Bacterial Diseases (impetigo, boils): To be considered “non-contagious,” all lesions must be scabbed over with no oozing or discharge and no new lesions should have
occurred in the preceding 48 hours. Oral antibiotic for three days is considered a minimum to achieve that status. If new lesions continue to develop or drain after 72 hours,
MRSA (Methicillin Resistant Staphylococcus Aureus) should be considered and minimum oral antibiotics should be extended to 10 days before returning the athlete to
competition or until all lesions are scabbed over, whichever occurs last.

Herpetic Lesions (Simplex, fever blisters/cold sores, Zoster, Gladiatorum): To be considered “non-contagious,” all lesions must be scabbed over with no oozing or dis-
charge and no new lesions should have occurred in the preceding 48 hours. For primary (first episode of Herpes Gladiatorum), wrestlers should be treated and not allowed
to compete for a minimum of 10 days. If general body signs and symptoms like fever and swollen lymph nodes are present, that minimum period of treatment should be
extended to 14 days. Recurrent outbreaks require a minimum of 120 hours or five full days of oral anti-viral treatment, again so long as no new lesions have developed
and all lesions are scabbed over.

Tinea Lesions (ringworm scalp, skin): Oral or topical treatment for 72 hours on skin and 14 days on scalp.

Scabies, Head Lice: 24 hours after appropriate topical management.

Conjunctivitis (Pink Eye): 24 hours of topical or oral medication and no discharge.

Molluscum Contagiosum: 24 hours after curettage.

–2–